Pharmacology of Mood stabilizers

Question 1

What are the antimanic drugs

Answer 1

Litihium salts (LiCO3 and LiCL), anticonvulsant drugs

Question 2

What are adjunctive drugs used to control mania

Answer 2

Antipsychotic agents, benzodiazepines, calcium channel antagonists

Question 3

What is the onset of action for lithium salts

Answer 3

Up to 3 weeks

Question 4

T/F: Lithium is a good substrate for the Na/K pump

Answer 4

False: Lithium is NOT a good substrate for the Na/K pump

Question 5

What are the propsed mechanisms of lithium action

Answer 5

Depleting 2n messesngers for ACh and NE trnsmission (PIP2, IP3, DAG), inhibits NE-adenylyl cyclase (lowering cAMP concentration), uncouples cGMP from G-proteint, disrupting neuronal transmission

Question 6

How does effect neurotransmission when using antipsychotics

Answer 6

Blocks development of dopamine supersensitivity

Question 7

When is the most important time to monitor lithium

Answer 7

Initiation of therapy

Question 8

What are the target levels for acute mania, maintenance

Answer 8

0.9-1.2 mEq/L, 0.6-0.9 mEq/L

Question 9

What the pharmokinetics of lithium

Answer 9

Readily abosrbed from the GI tract, reach peak in 2-4 hours

Question 10

T/F: Unique to lithium, final volume of distribution accurately approximates volume of distribution of total body water

Answer 10

True

Question 11

What is the side effect of fast rates of lithium increase, high lithium concentration

Answer 11

GI disturbance (nausea), polyuria (excess urination) and polydipsia (excess thirst)

Question 12

What causes the polyuria and polydipsia seen in high lithium concentrations

Answer 12

Uncopules G-protein from the vasopressin receptors, preventing the renal collecting ducts from conserving water even then in the presence of ADH

Question 13

T/F: Lithium causes hypothyroidism and is teratogenic

Answer 13

True

Question 14

What is kindling, how does this relate to mania

Answer 14

Repeated neuronal firing recruits neighboring neurons to fire in unison causing hypersensitivity to firing, less kindling leads to less recurrent episodes

Question 15

What are the anticonvulsants that are used for mania

Answer 15

Valporic acid, divalproex, carbamazepine, lamotrigine

Question 16

How does VPA work for mania treatment

Answer 16

Suppress glutamate activity and increases GABA activity

Question 17

What is divalproex, advantage, approved for

Answer 17

1:1 molar concentration of valproate Na and valproic acid, nausea and vomiting less common than with VPA, acute mania

Question 18

What is the MOA of carbameazpine for mania

Answer 18

Inhibits both sodium and potassium channels ENHANCing the inhibitiory action of GABA on high-frequency repetitive neuronal firing

Question 19

T/F: Oxcarbazepine has the same MOA as carbamezapine as a mood stabilizer

Answer 19

False: Ocarbazepine has never be proven to be a mood stabilizer and only blocks voltage sensitive sodium channels

Question 20

What is the MOA of lamotrigiine as a mood stabilizer

Answer 20

Inactivetes voltage-sensitive sodium channels reducing the release of glutamate

Question 21

What are the L-type calcium channels used for mood stabilizing, how do they aid in mood stabilization

Answer 21

Nimodipine and verapamil, Block calcium channels, thereby enhancing the inhibitory action of GABA

Question 22

What is the place of therapy for antipsychotics

Answer 22

Treat acute phase of manic episodes as adjunctive therapies

Question 23

What are they atypical antipsychotics used for acute mania

Answer 23

Olanzapine, quetiapine, risperidone, aripiprazole

Question 24

What are the typical psychotics used for acute mania

Answer 24

Chlopromazine, thioridazine

Question 25

What are the BZDs used for adjunctive therapy for mania episodes

Answer 25

Clonazepam and Lorazepam